马兜铃酸肾病尿毒症期维持性血透和肾脏移植的对比分析

Comparison of hemodialysis in patients with aristolochic acid nephropathy in uremia stage and renal transplantation

目的了解马兜铃酸肾病尿毒症期维持性血透或行肾移植后泌尿系肿瘤的发生情况及临床特点。方法回顾调查自2000年3月～2006年12月在温州医学院附属第一医院的38例尿毒症期马兜铃酸肾病患者,在分别接受维持性血透和肾移植后泌尿系肿瘤的发生情况及临床病理特点,以及分析肿瘤发生与透析时间的关联。结果38例马兜铃酸患者(血透患者15例,肾移植患者23例):随访11～85个月,肾移植患者中泌尿系肿瘤发生率13.0%(3/23)低于血透患者中泌尿系肿瘤发生率46.7%(7/15)(P<0.05),移植前透析时间与肿瘤的发生无统计学差异(P>0.05)。结论肾移植是尿毒症期马兜铃酸肾病患者较好的治疗措施,移植前透析时间与肿瘤的发生无关。

Objective To investigate the incidence and clinical characteristics of urinary carcinoma in the patients with aristolochic acid nephropathy （AAN） in uremia stage who received maintenance hemodialysis or renal transplantation. Methods The data of 38 AAN patients who had received renal replacement therapy and treated in the authors＇ service from Mar. 2000 to Dec. 2006 were reviewed, and the incidence and clinical pathological features of urinary carcinoma in these 38 AAN patients were summarized, in order to look for correlation between the frequency of hemodialysis and the occurrence of carcinoma. Results 15 of the 38 AAN patients received hemodialysis, and the remaining 23 patients underwent renal transplantation. During the follow-up period, seven patients who received hemodialysis were reported to have developed urinary carcinoma, the incidence was 46.7% （7/15）, which was significantly higher than the incidence in patients who had undergone renal transplantation （3/23, 13. 0%; P〈0. 05）. No obvious correlation was found between the frequency of hemodialysis and the incidence of carcinoma （ P〉0. 05）. Conclusion The prevalence of urinary carcinoma was much lower in the AAN patients who had undergone successful renal transplantation than in those patients who received only maintenance hemodialysis. Renal transplantation may be of a better treatment for the AAN patients in uremia stage. There was no correlation between the frequency of hemodialysis and the incidence of carcinoma.